User:Pandemics/Third plague pandemic

Third Pandemic is the designation of a major bubonic plague pandemic that began in Yunnan province in China in 1855, fifth year of the Xianfeng Emperor of the Qing dynasty. This episode of bubonic plague spread to all inhabited continents, and ultimately more than 12 million people died in India and China, with about 10 million killed in India alone. According to the World Health Organization, the pandemic was considered active until 1960, when worldwide casualties dropped to 200 per year.

The name refers to this pandemic being the third major bubonic plague outbreak to affect European society. The first was the Plague of Justinian, which ravaged the Byzantine Empire and surrounding areas in 541 and 542. The second was the Black Death, which killed at least one third of Europe's population in a series of expanding waves of infection from 1346 to 1353.

Casualty patterns indicate that waves of this late-19th-century/early-20th-century pandemic may have been from two different sources. The first was primarily bubonic and was carried around the world through ocean-going trade, through transporting infected persons, rats, and cargoes harboring fleas. The second, more virulent strain, was primarily pneumonic in character with a strong person-to-person contagion. This strain was largely confined to Asia, in particular Manchuria and Mongolia.

Pattern of the pandemic
The bubonic plague was endemic in populations of infected ground rodents in central Asia, and was a known cause of death among migrant and established human populations in that region for centuries. An influx of new people due to political conflicts and global trade led to the distribution of this disease throughout the world.

Origin in Yunnan Province of China
A natural reservoir or nidus for plague is located in western Yunnan and is an ongoing health risk today. The third pandemic of plague originated in this area after a rapid influx of Han Chinese to exploit the demand for minerals, primarily copper, in the latter half of the nineteenth century. By 1850, the population had exploded to over 7 million people. Increasing transportation throughout the region brought people in contact with plague-infected fleas, the primary vector between the yellow-breasted rat (Rattus flavipectus) and humans. People brought the fleas and rats back into growing urban areas, where small outbreaks sometimes reached epidemic proportions. The plague spread further after disputes between Han Chinese and Hui Muslim miners in the early 1850s erupted into a violent uprising known as the Panthay rebellion, which led to further displacements (troop movements and refugee migrations). The outbreak of the plague helped recruit people into the Taiping Rebellion. In the latter half of the nineteenth century the plague began to appear in Guangxi and Guangdong provinces, Hainan Island, and later the Pearl River delta including Canton and Hong Kong. While William McNeil and others thought that the plague was brought from the interior to the coastal regions by troops returning from battles against the Muslim rebels, Benedict suggests that the evidence favors the growing and lucrative opium trade that began after about 1840.

In the city of Canton, beginning in March 1894, the disease killed 60,000 people in a few weeks. Daily water-traffic with the nearby city of Hong Kong rapidly spread the plague. Within two months, after 100,000 deaths, the death rates dropped below epidemic rates, although the disease continued to be endemic in Hong Kong until 1929.

Political impact in colonial India


The plague, which was brought from Hong Kong to British India, killed about 10 million in India, it later also killed another 12.5 million in the British colony India in the next following thirty years. Almost all cases were bubonic, with only a very small percentage changing to pneumonic plague. (Orent, p. 185) The disease was initially seen in port cities, beginning with Bombay (now Mumbai), but later emerged in Pune, Kolkata, and Karachi (now in Pakistan). By 1899, the outbreak spread to smaller communities and rural areas in many regions of India. Overall, the impact of plague epidemics was greatest in western and northern India—in the provinces then designated as Bombay, Punjab, and the United Provinces—while eastern and southern India were not as badly affected.

The colonial government's measures to control the disease included quarantine, isolation camps, travel restrictions and the exclusion of India's traditional medical practices. Restrictions on the populations of the coastal cities were established by Special Plague Committees with overreaching powers, and enforced by the British military. Indians found these measures culturally intrusive and, in general, repressive and tyrannical. Government strategies of plague control underwent significant changes during 1898–1899. By that time, it was apparent that the use of force in enforcing plague regulations was proving counter-productive and, now that the plague had spread to rural areas, enforcement in larger geographic areas would be impossible. At this time, British health officials began to press for widespread vaccination using Waldemar Haffkine’s plague vaccine, although the government stressed that inoculation was not compulsory. British authorities also authorized the inclusion of practitioners of indigenous systems of medicine into plague prevention programs.

Repressive government actions to control the plague led the Pune nationalists to criticise the government publicly. On 22 June 1897, the Chapekar brothers, young Pune Hindus, shot and killed Walter Charles Rand, an Indian Civil Services officer acting as Pune Special Plague Committee chairman, and his military escort, Lieutenant Ayerst. The action of the Chapekars was seen as terrorism. The government also found the nationalist press guilty of incitement. Independence activist Bal Gangadhar Tilak was charged with sedition for his writings as editor of the Kesari newspaper. He was sentenced to eighteen months rigorous imprisonment.

Public reaction to the health measures enacted by the British Indian state ultimately revealed the political constraints of medical intervention in the country. These experiences were formative in the development of India's modern public health services.

Global distribution
The network of global shipping ensured the widespread distribution of the disease over the next few decades. Recorded outbreaks include:


 * Pakhoi, China 1882.
 * Canton, China 1894.
 * Hong Kong 1894.
 * Taiwan, Japan 1896 (until 1923 Great Kantō earthquake).
 * Jeddah, 1896.
 * Mecca, 1898.
 * Medina, 1898.
 * Bombay Presidency, India 1896–1898.
 * Calcutta, India 1898.
 * Madagascar, 1898.
 * Kobe, 1898.
 * San Francisco, 1899.
 * Egypt, 1899.
 * Manchuria, China 1899.
 * Paraguay, 1899.
 * South Africa, 1899–1902.
 * Republic of Hawaii, 1899.
 * Glasgow, United Kingdom, 1900.
 * San Francisco, United States, 1900.
 * Manila, 1900.
 * Australia, 1900–1905.
 * Russian Empire/Soviet Union, 1900–1927.
 * Fukien Province, China 1901.
 * Siam, 1904.
 * Burma, 1905.
 * Tunisia, 1907.
 * Trinidad, Venezuela, Peru and Ecuador, 1908.
 * Bolivia and Brazil, 1908.
 * Cuba and Puerto Rico, 1912.

Each of these areas, as well as Great Britain, France, and other areas of Europe, continued to experience plague outbreaks and casualties until the 1960s. The last significant outbreak of plague associated with the pandemic occurred in Peru and Argentina in 1945.

The 1894 Hong Kong plague
The 1894 Hong Kong plague was a major outbreak of the third pandemic in the world from the late 19th century to the early 20th century. In May 1894, the first case occurred in Hong Kong. The patient was a national hospital clerk and was discovered by Dr. Yu Xun, the dean of the National Hospital, who had just returned from Guangzhou. When the Chinese-style buildings were built, the Taiping Mountain area in Sheung Wan, the most densely populated area in Hong Kong, became the hardest hit area of the epidemic. Controlling the epidemic naturally became the top priority of the Governor of Hong Kong. From May to October 1894, the plague in Hong Kong killed more than 2,000 people and one-third of the population fled Hong Kong. In the 30 years after 1926, the plague occurred in Hong Kong almost every year, killing more than 20,000 people. Through the maritime traffic in Hong Kong, the plague epidemic originating in Yunnan, China, spread to all parts of the country after 1894 and eventually spread to all continents where humans live.

There were several reasons for the rapid outbreak and rapid spread of the plague. First, in the early days of Kailuan, Sheung Wan was a Chinese settlement. It is located in the mountains. The design of the houses there included no drainage channels, toilets or running water. Intensive buildings and a lack of floor tiles were also weaknesses in housing design at the time. Secondly, during the Ching Ming Festival in 1894, many Chinese living in Hong Kong returned to the countryside to sweep the graves, which coincided with the outbreak of the epidemic in Guangzhou and the introduction of bacteria into Hong Kong. In addition, in the first four months of 1894, rainfall decreased and soil dried up, accelerating the spread of the plague.

The measures mainly included three aspects: setting up plague hospitals and deploying medical staff to treat and isolate plague patients; conducting house-to-house search operations, discovering and transferring plague patients, and cleaning and disinfecting infected houses and areas; and setting up designated cemeteries and assigning a person responsible for transporting and burying the plague dead.

Disease research
Researchers working in Asia during the "Third Pandemic" identified plague vectors and the plague bacillus. In 1894, in Hong Kong, Swiss-born French bacteriologist Alexandre Yersin isolated the responsible bacterium (Yersinia pestis, named for Yersin) and determined the common mode of transmission. His discoveries led in time to modern treatment methods, including insecticides, the use of antibiotics and eventually plague vaccines. In 1898, French researcher Paul-Louis Simond demonstrated the role of fleas as a vector.

The disease is caused by a bacterium usually transmitted by the bite of fleas from an infected host, often a black rat. The bacteria are transferred from the blood of infected rats to the rat flea (Xenopsylla cheopsis). The bacillus multiplies in the stomach of the flea, blocking it. When the flea next bites a mammal, the consumed blood is regurgitated along with the bacillus into the bloodstream of the bitten animal. Any serious outbreak of plague in humans is preceded by an outbreak in the rodent population. During the outbreak, infected fleas that have lost their normal rodent hosts seek other sources of blood.

The British colonial government in India pressed medical researcher Waldemar Haffkine to develop a plague vaccine. After three months of persistent work with a limited staff, a form for human trials was ready. On January 10, 1897 Haffkine tested it on himself. After the initial test was reported to the authorities, volunteers at the Byculla jail were used in a control test, all inoculated prisoners survived the epidemics, while seven inmates of the control group died. By the turn of the century, the number of inoculees in India alone reached four million. Haffkine was appointed the Director of the Plague Laboratory (now called Haffkine Institute) in Bombay.